How to manage breathing issues from allergies?

Question

Hello doctor,

I have been experiencing breathing difficulties with occasional coughing, sticky mucus in the back of my throat, and a constant need to clear it. I also feel tightness in my chest, sometimes like it is rubbing, and have persistent sneezing and itching all over my body. These symptoms have been ongoing for the past six years. Around two years ago, my breathing worsened while living in an old garage apartment.

I consulted an allergy specialist, who prescribed Fexofenadine 180 mg and Flonase. I was also concerned about asthma and got tested, but the results were normal. I still have an inhaler for use before exercise. I stopped medications when my allergies were less severe during the year, but now that fall is here, the symptoms, especially the breathing difficulty, have returned. The cough occurs occasionally throughout the year. I currently do not have a runny nose or frequent sneezing.

My concerns are:

Could this be more than just allergies, or should I be worried about another condition?
Should I be concerned about the medications I am taking?
The effects of Fexofenadine and Flonase seem to last only about eight hours. Does this mean I need higher doses?
What are the risks of taking increased amounts of an antihistamine?

This is causing me significant anxiety, and I would greatly appreciate your guidance.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for providing such a detailed history. It really helps in understanding your situation. Based on your symptoms, it seems likely that allergies are the main cause. Here is what I suggest:

Allergy testing: A skin prick test is the gold standard for identifying specific allergens. This will help us target treatment more effectively. Before the test, you should stop taking antihistamines, sleeping pills, and steroid medications for accurate results.
Medications: For your current symptoms, a combination approach often works better than a single antihistamine:
- Oral medications: Fexofenadine 180 mg plus Montelukast 10 mg once daily.
- Nasal spray: A combination of Fluticasone furoate and Azelastine twice daily can help reduce nasal symptoms and improve compliance.
If symptoms persist: If breathing difficulties continue after two days, inhalers like Levosalbutamol or Albuterol may be needed. Depending on chest findings, a steroid inhaler might be added.
Long-term plan: Once your acute symptoms are controlled, you can stop oral medications and proceed with the skin prick test. This will allow us to develop a personalized management plan for lasting relief.

Following this plan should help control your symptoms effectively while minimizing unnecessary medication use.

I hope this helps, and please reach out if you notice any worsening or new symptoms.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

You can take those medicines together at the same time of the day. It is better to take Fexofenadine two hours before going to bed and Montelukast in the daytime. The chest symptoms that you need to watch for are wheezing, breathing sounds, itching in the chest, and fingers going blue due to lack of oxygen.

I hope this helps.

Thank you.